CMS Price Transparency Data

Blood test, comprehensive metabolic panel

Facility: UPMC Pinnacle Hospitals

Billing Code: 80053 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 80053
Insurance Median: $54
Cash Discount Price: $56
vs. Medicare Baseline: 5.11x Medicare

The contracted insurance negotiated median rate for a Blood test, comprehensive metabolic panel at UPMC Pinnacle Hospitals is $54. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $56. Compared to the federal Medicare reimbursement reference rate of $10.56, this hospital’s rate is 5.11x the Medicare baseline. Located in 409 South Second Street, Harrisburg, PA.

Cash / Self-Pay

$56

Average discount available for prompt cash payment at this facility.

Insurance Median

$54

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$10.56

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $10.56 (100%)

Cash / Self-Pay: $56 (530%)

Insurance Median: $54 (511%)

Cash: $56 (530% of Medicare)

Ins. Median: $54 (511% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $10.56 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 511% of the Medicare baseline (a markup of 411%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Blue Cross Blue Shield	$10 - $112	95%
Aetna	$11 - $84	104%
Cigna	$11	104%
Humana	$11	104%
Pa Health & Wellness	$11 - $20	104%
UnitedHealthcare	$11 - $15	104%
Upmc Work Partners	$11	104%
Amerihealth Caritas	$12	114%
Keystone Health Plan	$15 - $62	142%
Health Partners Plans (Jefferson Health Plan)	$16	152%
Geisinger	$17	161%
Prime Net	$18 - $86	170%
Intergroup	$47 - $97	445%
Wellspan Population Health	$62 - $97	587%
Upmc Health Plan	$72	682%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $56.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 80053.

Insurance In-Network Protection Plan

Contact your insurance company to confirm UPMC Pinnacle Hospitals is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 80053.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.